Hypertension Improvement Pilot Intervention in Post-Stroke Veterans

中风后退伍军人的高血压改善试点干预

• 批准号: 9982060
• 负责人: Jason Jonathon Sico
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982060
• 关键词: Acute; Address; Administrator; Adoption; Adult; Affect; Ambulatory Care; American Heart Association; American Stroke Association; Antihypertensive Agents; Area; Blood Pressure; Caring; Categories; Cause of Death; Cessation of life; Characteristics; Computerized Patient Records; Consultations; Data; Development; Education; Evaluation; Event; Frequencies; Future; General Population; Goals; Guidelines; Health Information System; Health Services Research; Healthcare Systems; Hospitalization; Hypertension; Information Technology; Infrastructure; Inpatients; Intervention; Interview; Investigator-Initiated Research; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Measures; Medical center; Methods; Morbidity - disease rate; Neurologist; Outpatients; Patient Care; Patients; Pharmaceutical Preparations; Population; Prevention; Primary Health Care; Process; Provider; Recurrence; Research; Risk; Risk Factors; Site; Stress; Stroke; Suggestion; System; Testing; Time; Veterans; Work; adjudication; base; blood pressure regulation; care providers; career development; cerebrovascular; clinical practice; disability; effective intervention; evidence base; health administration; high risk; hypertension control; implementation research; implementation science; implementation strategy; improved; improved outcome; inpatient service; intervention effect; mortality; post stroke; prevent; programs; secondary outcome; statistics; stroke risk; stroke survivor; therapy design; tool; uptake; virtual

Background: Over 6,000 Veterans are admitted with an acute ischemic stroke annually within the VA Healthcare System. Nearly 25% of all strokes are recurrent events and constitute a leading cause of disability and death within our Veteran population, especially among the 75% of Veterans with stroke and hypertension. Current VA/DoD and American Heart Association/American Stroke Association (AHA/ASA) guidelines stress the importance of delivering guideline concordant management of hypertension, given the strong association between goal blood pressure and decreased morbidity and mortality, especially during the six-month post- stroke period, when most stroke and non-stroke related hospitalizations and deaths occur. Previous Quality Enhancement Research Initiative (QUERI) work has shown that many Veterans 6-months after their stroke do not have their blood pressure optimally controlled. Most Veterans receive their post-stroke risk hypertension care within VA Primary Care and Patient Aligned Care Teams (PACTs). Work performed during the current Health Services Research and Development (HSR&D) Career Development Award (CDA) period has identified several areas for intervention that can assist outpatient providers in Primary Care/PACT to better manage hypertension using existing VA infrastructure, and has led to the development of a bundled, evidence-based, `Post Stroke Hypertension Improvement Intervention.' Therefore, focusing on prevention of future strokes by implementing an intervention to effectively treat hypertension among Veterans with stroke is necessary to improve outcomes in this population. Objective: To: (1) evaluate the feasibility and acceptability of a pilot intervention, implemented at a single VAMC providing suboptimal blood pressure management to post-stroke Veterans, during the `high-risk,' 6- month period post-stroke, such that a more refined intervention can be developed and further informed by key stakeholders, end users, and strategic partners; and (2) collect metrics related to hypertension control at the intervention and four control sites. Methods: A pilot will be initiated at the Michael E. DeBakey VAMC. The Consolidated Framework for Implementation Research (CFIR) conceptual framework and Systems Redesign strategies will be used to evaluate the implementation of the intervention. The feasibility and acceptability of the implementation strategy will be assessed via qualitative interviews with end users of the intervention. Blood pressure will be measured at baseline, 3-months, and 6-months. The distributions and central tendencies of baseline demographic and patient-, provider-, and facility-level characteristics for continuous variables will be examined graphically and by summary statistics. Categorical variables will be examined by calculating frequency distributions. We will match, based on patient volume and mean facility-level blood pressure, our intervention and control sites. Hypothesis: We believe that we can: (1) determine the feasibility and acceptability of a pilot intervention designed to improve post-stroke hypertension control 6-months after discharge; and (2) collect metrics related to hypertension control among Veterans participating in the intervention and four control sites to estimate effect size for a future, larger trial. Conclusion: Interventions that improve management of hypertension among Veterans with ischemic stroke are necessary to prevent recurrent strokes; implementation science strategies can assess the uptake and sustainability of this intervention.

背景：每年有超过6,000名退伍军人因急性缺血性卒中入院 医疗系统。在所有中风中，近25%是复发性事件，是导致残疾的主要原因 和死亡在我们的退伍军人人口，特别是在75%的退伍军人中风和高血压。 当前VA/DoD和美国心脏协会/美国卒中协会（AHA/阿萨）指南强调 考虑到高血压与高血压的密切相关性， 目标血压与发病率和死亡率下降之间的关系，特别是在治疗后6个月内， 中风期间，大多数中风和非中风相关的住院和死亡发生。在先质量 增强研究计划（QUERI）的工作表明，许多退伍军人在中风后6个月内 他们的血压没有得到最佳控制。大多数退伍军人接受他们的中风后高血压风险 VA初级护理和患者对齐护理团队（PACTs）内的护理。本报告所述期间开展的工作 卫生服务研究与发展（HSR&D）职业发展奖（CDA）期间已确定 几个干预领域，可以帮助初级保健/PACT的门诊提供者更好地管理 高血压使用现有的VA基础设施，并导致了捆绑，循证， “中风后高血压改善干预。“因此，通过以下措施预防未来的中风， 有必要实施干预措施，有效治疗退伍军人中风患者的高血压， 改善这一人群的结果。 目的：（1）评价试点干预的可行性和可接受性，在一个单一的实施， VAMC为中风后退伍军人提供次优血压管理，在“高风险”期间，6- 中风后一个月的时间，这样就可以制定更精细的干预措施，并通过关键 利益相关者，最终用户和战略合作伙伴;（2）收集与高血压控制相关的指标， 干预和四个控制点。 方法：将在Michael E. DeBakey VAMC。综合框架 实施研究（CFIR）概念框架和系统重新设计策略将用于 评估干预措施的实施情况。实施战略的可行性和可接受性 将通过与干预措施最终用户的定性访谈进行评估。将测量血压 在基线、3个月和6个月时。基线人口统计学和 连续变量的患者、提供者和机构水平特征将通过图形和 统计摘要。将通过计算频率分布检查分类变量。我们将 根据患者数量和平均设施水平血压，匹配我们的干预和对照部位。 假设：我们认为我们可以：（1）确定试点干预的可行性和可接受性 旨在改善出院后6个月的卒中后高血压控制;（2）收集相关指标 对参加干预的退伍军人和四个对照点的高血压控制效果进行评价 为将来更大规模的试验做准备 结论：改善退伍军人缺血性卒中高血压管理的干预措施是 预防复发性中风所必需的;实施科学策略可以评估 这种干预的可持续性。